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Insulin Sliding Scales Could Cost You Big Money

02/10/2021 2:00 PM | Anonymous member (Administrator)

Insulin continues to be one the most targeted medication for audits. Having an insulin prescription with a sliding scale attached can be easy prey for auditors. Anytime there is a sliding scale on insulin, a daily maximum number of units must be on the prescription in order to calculate an accurate days’ supply. Let us look at a few examples of some written instructions that an auditor could flag:

  1. Use as Directed
  2. Per Sliding Scale
  3. Inject 30 units in the morning, 20 units at night and as per sliding scale
    • Auditor will not assume maximum daily dose is 50 units
  4. Inject 35 units once daily. If blood sugar greater than 130, increase by 3 units every three days until lower than 130
    • Auditor will not assume maximum daily dose is 35 units


PAAS Tips:

  • Call the doctor’s office to obtain an estimated maximum number of units per day when the instructions are written for “use as directed” or anytime a sliding scale is attached
    • Document a clinical note on the hard copy (who you spoke with and their title, date and time, maximum number of units clarified and your initials)
  • Clarify the maximum number of units per day prior to the first fill
    • Be sure to include the maximum daily dose on the patient label
    • PBMs may mark the prescription discrepant if the directions are not on the patient label or clarified after dispensing
  • You must obtain a maximum number of units per day even if you are dispensing the smallest package size (i.e. 1 vial or 1 box of insulin pens)


PAAS National® is committed to serving community pharmacies and helping keep hard-earned money where it belongs. Contact us today at (608) 873-1342 or info@paasnational.com to see why membership might be right for you.

By Trenton Thiede, PharmD, MBA, President at PAAS National®, expert third party audit advice and FWA/HIPAA compliance.

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